AHIP AHM-540 - Medical Management Exam
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Total 163 questions
Question #1 (Topic: )
PBMs are accredited by the same organizations that accredit health plans.
A. True
B. False
Answer: B
Question #2 (Topic: )
The Westchester Health Plan classifies its key processes into the following categories:
high-risk, high-volume, problem-prone, and high-cost. Westchester also prioritizes the
categories in terms of importance. The process category that Westchester most likely ranks
highest in importance is
high-risk, high-volume, problem-prone, and high-cost. Westchester also prioritizes the
categories in terms of importance. The process category that Westchester most likely ranks
highest in importance is
A. High-risk processes
B. High-volume processes
C. Problem-prone processes
D. High-cost processes
Answer: A
Question #3 (Topic: )
With respect to the activities of MCO medical directors, it is correct to say that medical
directors typically perform all of the following activities EXCEPT
directors typically perform all of the following activities EXCEPT
A. maintaining clinical practices
B. delivering performance feedback to providers
C. participating in utilization management (UM) activities
D. educating other MCO staff about new clinical developments or provider innovations that might impact clinical practice management
Answer: A
Question #4 (Topic: )
Federal laws, such as the Employee Retirement Income Security Act (ERISA), the
Balanced Budget Act (BBA) of 1997, and the Health Insurance Portability and
Accountability Act (HIPAA), have affected medical management activities by health plans.
Consider the following provisions of federal regulations:
Provision 1Limits damage awards in lawsuits related to noncoverage of benefits based
on medical necessity decisions to the cost of noncovered treatment and does not allow
health plan members to obtain compensatory or punitive damages
Provision 2Establishes electronic data security standards, which define the security
measures that healthcare organizations must take to protect the confidentiality of
electronically stored and transmitted patient information From the answer choices below,
select the response that correctly identifies the federal laws that include Provision 1 and
Provision 2, respectively.
Balanced Budget Act (BBA) of 1997, and the Health Insurance Portability and
Accountability Act (HIPAA), have affected medical management activities by health plans.
Consider the following provisions of federal regulations:
Provision 1Limits damage awards in lawsuits related to noncoverage of benefits based
on medical necessity decisions to the cost of noncovered treatment and does not allow
health plan members to obtain compensatory or punitive damages
Provision 2Establishes electronic data security standards, which define the security
measures that healthcare organizations must take to protect the confidentiality of
electronically stored and transmitted patient information From the answer choices below,
select the response that correctly identifies the federal laws that include Provision 1 and
Provision 2, respectively.
A. Provision 1- ERISA Provision 2- HIPAA
B. Provision 1- HIPAA Provision 2- ERISA
C. Provision 1- BBA of 1997 Provision 2- HIPAA
D. Provision 1- ERISA Provision 2- BBA of 1997
Answer: A
Question #5 (Topic: )
For this question, if answer choices (A) through (C) are all correct, select answer choice
(D). Otherwise, select the one correct answer choice.
Many health plans use data warehouses to assist with the performance of medical
management activities. With respect to the characteristics of data warehouses, it is
generally correct to say
(D). Otherwise, select the one correct answer choice.
Many health plans use data warehouses to assist with the performance of medical
management activities. With respect to the characteristics of data warehouses, it is
generally correct to say
A. that the construction of a data warehouse is quick and simple
B. that a data warehouse addresses the problems associated with multiple data management systems
C. that a data warehouse stores only current data
D. all of the above
Answer: B
